This invention relates generally to patient support apparatus, and in particular to method and apparatus for protecting a patient's head, neck and face during a surgical procedure that is performed while the patient is lying in a prone position or seated leaning forward.
During some surgical procedures, it is necessary to support a patient in the prone (face down) position on an operating table. For example, the prone position is used during the following procedures: back surgery, laminectomies, fusions, instrumentations, scoliosis surgery, hemorrhoidectomies, colorectal surgery, Achilles tendon repair, decubitus ulcer debridement, myocutaneous flaps, hip surgery, neck surgery, spinal tumors, removal of Baker's cysts, calcaneal fractures and the like.
A continuing difficulty facing the medical practitioner, when positioning the patient so that pressure is exerted on his face, is avoiding injury to the patient's head and face. There are many well-known complications that can occur if the patient's face and head are not positioned or supported properly. These complications result from the continued interruption of blood flow to soft tissue areas, and include the following: soft tissue necrosis and sloughing with possible infection, necrosis of the cartilaginous support structures of the nose and ear, corneal ulceration, conjunctival edema, blindness, central or branch retinal artery occlusion, and increased intraocular pressure. During the course of surgery in the prone position, it is necessary to monitor the vital structures of the patient's face every few minutes so that facial injury caused by compression of soft, sensitive facial tissue can be avoided.
Moreover, the patient's head must be positioned and his airway must be properly aligned to accommodate endotracheal instruments used to administer general anesthetics and oxygen during major surgical procedures.
A variety of support arrangements have been proposed for supporting a patient's face and head while the patient is lying in a prone position. Typically, the patient's head and face are supported between two or more foam cushions, pillows or towels, with the support members being manually repositioned every few minutes to relieve the accumulation of pressure on the patient's sensitive facial tissues. This support arrangement has obvious disadvantages in that it requires an attendant's close attention to carefully shift the resting position of the patient's head while maintaining airway alignment with tracheal intubation equipment. Proper management of intubation equipment is restricted by the placement of supporting cushions or towels that obscure the observation of facial features.
One approach that provides facial support while also allowing close observation and airway management is disclosed in U.S. Pat. No. 5,220,699. According to that disclosure, a contoured, inflatable mask is mounted on a rigid basket that supports a patient's head and face while the patient is lying in a prone position. The surgical face mask uses an inflatable chamber for providing soft, cushion support for the patient's forehead and face. An advantage of that arrangement is that the pressure of facial engagement is spread over a relatively large, contoured surface. However, the soft facial tissues are subject to compression injury in that arrangement, since the facial area of engagement remains unchanged over a relatively long period of time, thus causing the continuous interruption of blood flow to those soft tissue areas and various resulting damage.
Another prone support arrangement is disclosed in U.S. Pat. No. 5,287,567 in which a patient's chin and forehead are supported on an inflatable chin support pad and an inflatable forehead support pad. The soft tissues of the patient's forehead and chin are subjected to compression injury and interruption of blood circulation since the areas of skin contact remain unchanged throughout the procedure.
A similar arrangement for facial support in the prone position is described in U.S. Pat. No. 5,520,623. In that arrangement, a forehead pad and a chin pad (neither of which is inflatable) are supported on a rigid basket frame which maintains the patient's face elevated above a support surface during a surgical procedure.
Another facial support for a patient lying in the prone position is disclosed in U.S. Pat. No. 5,269,035 in which a block of soft, closed cell foam is contoured for conforming, resilient support of the patient's head and face. U.S. Pat. Nos. 4,504,050 and 4,752,064 also disclose head support devices for supporting a patient's face in the prone position. Those support devices are not inflatable and impose a continuous compression force on sensitive facial, neck and head areas while also maintaining the patient's head in a fixed position.
Yet another head support arrangement is shown in U.S. Pat. No. 5,044,026 in which a face pillow is formed by two sponge cylinders that are coupled together in spaced relation to permit a patient to lie face down in a prone position with a ventilation passage being formed adjacent the patient's mouth and nostrils.
Other support arrangements are known for patients needing full body support to prevent pressure sores, decubitus ulcers, and head and shoulder support while the patient is in the supine position. For example, U.S. Pat. No. 5,184,365 discloses inflatable support bags that are pressurized for the purpose of aligning the patient's mouth, pharynx and trachea to accommodate tracheal intubation in the supine position.